Provider Demographics
NPI:1205892601
Name:FERNANDEZ, HECTOR FELIPE
Entity type:Individual
Prefix:
First Name:HECTOR
Middle Name:FELIPE
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8130 ROYAL PALM BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-5703
Mailing Address - Country:US
Mailing Address - Phone:954-346-5044
Mailing Address - Fax:954-346-5078
Practice Address - Street 1:8130 ROYAL PALM BLVD STE 200
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5703
Practice Address - Country:US
Practice Address - Phone:954-346-5044
Practice Address - Fax:954-346-5078
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0061881207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF66281Medicare UPIN
FL23333XMedicare PIN